Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents.

Abstract

OBJECTIVES:

The aim of this research was to assess the efficacy of paclitaxel-eluting stents in chronic total coronary occlusions (CTO).

BACKGROUND:

Percutaneous coronary interventions for CTOs are characterized by a high target vessel failure rate.

METHODS:

In 48 consecutive patients, paclitaxel-eluting stents (Taxus, Boston Scientific Corp., Natick, Massachusetts) were implanted after successful recanalization of a CTO (duration >2 weeks). Patients underwent an angiography after 6 months and were followed clinically for 12 months. They were compared with 48 lesion- and risk-matched patients with CTOs treated with bare metal stents (BMS). Primary clinical end point was the one-year incidence of major adverse cardiac events (MACE) (death, myocardial infarction, repeat revascularization); secondary end points were the rate of restenosis and re-occlusion.

RESULTS:

In-hospital MACE was 4.2% with Taxus, and 2.1% with BMS (p = NS). The one-year MACE rate was 12.5% in the Taxus group, and 47.9% in the BMS group (p < 0.001), which was due to a reduced need for repeat revascularization. The angiographic restenosis rate was 8.3% with Taxus versus 51.1% with BMS (p < 0.001). There was only one late re-occlusion with Taxus (2.1%) as compared with 23.4% with BMS (p < 0.005). The late loss was reduced in the Taxus group by 84% as compared with BMS. All nonocclusive restenoses in the Taxus group were focal and successfully treated by implanting an additional Taxus stent.

CONCLUSIONS:

The treatment of CTOs with a paclitaxel-eluting stent drastically reduces MACE and restenosis, and almost eliminates re-occlusion, which is typically frequent with BMS in CTOs. Chronic total coronary occlusion should be a preferred indication for drug-eluting stents.

• Authors: Gerald S Werner, Andreas Krack, Gero Schwarz, Dirk Prochnau, Stefan Betge, Hans R Figulla
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 44 Issue 12 Pg. 2301-6 (Dec 21 2004) ISSN: 0735-1097 [Print] United States
• PMID: 15607390 (Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article)

Chemical References

• Paclitaxel

Topics

• Aged
• Angioplasty, Balloon, Coronary
• Chronic Disease
• Cohort Studies
• Coronary Angiography
• Coronary Disease (diagnostic imaging, prevention & control, therapy)
• Coronary Restenosis (diagnostic imaging, epidemiology, mortality, prevention & control, therapy)
• Diabetic Angiopathies (diagnostic imaging, prevention & control, therapy)
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Paclitaxel (administration & dosage)
• Secondary Prevention
• Stents
• Survival Analysis
• Treatment Outcome